Outcomes in the Management of Sternal Dehiscence by Plastic Surgery

In Brief Purpose: Infection rates following median sternotomy vary between 0.2% and 10%. These cases are associated with morbidity and mortality rates between 10% and 25% and 5% and 20%, respectively. The purpose of this study was to evaluate patient outcomes following plastic surgery correction of sternotomy dehiscence (SD). Methods: All patients operated on for an SD following coronary artery bypass graft surgery (CABG), between 1995 and 2005, with 1 or more flaps, were included. Results: Eighty cases were identified over a 10-year period. The mean age was 64 (±9.1) years. Two or more procedures were required in 17.5% of patients, and the mortality rate within 30 days was 12.5%. Significant variability was revealed between the cumulative mortality rates of plastic surgeons, from 0.0% to 50.0%. Multiple associations were identified for poor outcome, including chronic renal insufficiency and early mortality, and obesity with risk of reintervention. Conclusion: Although patients who undergo surgical correction of a deep sternal infection usually tolerate their intervention well, the mortality within 30 days remains high. This study has identified several factors explaining morbidity and mortality in this patient population. A review of flap reconstructions of 80 post-sternotomy infections demonstrated the need for multiple procedures in 17.5% and a 30-day mortality rate of 12.5%. Obesity was a risk factor for reoperation, and chronic renal failure for mortality.